Vessel harvesting retractor with integral electrosurgical clamping elements

ABSTRACT

An endoscopic vessel harvesting device and a method of endoscopic harvesting of vessels from a patients body. The method comprises locating the vessel, and inserting the vessel harvesting device through an incision. Dissecting the vessel from the surrounding tissue, and capturing side branch vessels in a vessel capturing means. Ligating and transecting the side branch vessels using electrodes and a knife located in the vessel capturing means. Finally, ligating and transecting the vessel, and removing the vessel from the patients body. The vessel harvesting device comprises a head piece, a shaft having a lumen for receiving an endoscope, and a vessel capturing means located on the head piece for capturing the side branch vessels in the receiver.

CROSS-REFERENCE TO RELATED APPLICATIONS

[0001] This application is a continuation of application Ser. No.09/967,201, filed on Sep. 28, 2001, which is incorporated herein by itsentirety.

FIELD OF THE INVENTION

[0002] The present invention relates generally to vessel harvesting andin particular to an improvement over existing endoscopic vesselharvesting techniques and devices.

BACKGROUND OF THE INVENTION

[0003] Endoscopic harvesting of vessels is well known in the surgicalfield and has been the subject of a great deal of recent technologicaladvancement. Typically, the harvesting of vessels is performed so thatthe vessels can then be used for procedures such as Cardio Artery BypassGrafting (CABG). In this procedure the saphenous veins of the legs areharvested for subsequent use in the CABG surgery.

[0004] Devices and methods for such vessel harvesting are well known andhave been described in numerous publications including U.S. Pat. No.5,667,480 issued Sep. 16, 1997 and U.S. Pat. No. 5,722,934 issued Mar.3, 1998 to Knight et al, both of which are incorporated herein by theirreference. The devices and methods of these patents are brieflydescribed below and are shown in FIGS. 1 and 2.

[0005] In the traditional harvesting devices as shown in FIG. 1, thereis provided a hollow shaft 12 connected to a concave head piece 16located at the distal end of the shaft which provides a workspace 18. Anendoscope 5 with a distal end 6 is typically inserted in the shaft sothat the surgeon may view workspace. The edge of the head piece 17 isused for dissecting the vessel from the surrounding tissue as shown inFIG. 2. The device may also have guide rails located on the underside ofthe device which allow for the entry of other devices such asdissectors, ligation tools, and cutting tools into the workspace.

[0006] The traditional method for removal of a vessel section as shownin FIG. 2 is as follows. Initially an incision 3 is made and the vessel7 is located. Then, the vessel 7 is dissected from the surroundingtissue using the leading edge of the head piece 16 of the device 10 toseparate the tissue from the vessel 7. At this time there is sufficientworkspace 18 created around the vessel 7 so that other instruments canbe inserted into the incision 3 via the guide rails located on theunderside of the device. These instruments include ligation tools forsecuring side branch vessels, a vessel dissector for performing a morecomplete dissection of the vessel which is to be removed, andlaproscopic scissors for the transection of both the side branch vessels9 and the vessel 9 which is to be removed.

[0007] Of the known devices and methods for removal of vessels thereremains one constant problem. The problem is that to perform each anevery one of the side branch ligation and transactions, extra tools mustbe inserted along the guide rails of the device through the originalincision. Often times this means that to perform a single transection ofa side branch vessel three tools must be inserted in succession into thebody. The various tools include, a dissector to dissect the side branchfrom the surrounding tissue, a ligation tool to clamp the side branchvessel and the vessel to be removed, and a cutting tool to perform thetransection. Additionally, the harvesting device remains in the bodythroughout the procedure.

[0008] This requirement of inserting the tools in succession andexchanging one tool for another to perform each step of the operationrequires extra time, this in turn can be a drain on the individualsurgeons resources. Further, because of this increased amount of time,which the surgeon requires to perform the operation, the stress on thepatient is increased. Minimization of patient stress is naturally aconcern during any surgical procedure. Therefore, the elimination ofsome or all of the time extending tool exchanges would greatly benefitnot only the patient but the surgeon as well.

SUMMARY OF THE INVENTION

[0009] The present invention is directed to solving the shortcomings ofknown vessel harvesting devices, by providing a superior vesselharvesting device, promoting efficient removal of vessels, and limitingthe stress on patients. The objects of the present invention are theminimization of the tool exchanges, increased efficiency of operation,minimization of patient stress, and increased ease of the overallharvest operation. The present invention pertains to a device having ameans for capturing side branch vessels so that they may be ligated andtransected. The present invention provides for in a single instrumentthe features that traditionally required at least two and often moreinstruments. Currently, these several instruments are introduced throughthe same incision, and held together with the endoscopic portionsapproximately parallel. This is often referred to as “sword fighting”due to the complications associated with performing the procedure.“Sword fighting” often traumatizes the incision and the internal tissuestructures. The effect of requiring two hands to perform the procedurecoupled with fact that operators may include both surgeons and surgicalassistants of varying skill highlights the advantages of developing asingle device to perform these varied tasks. Thus, a single instrumentcombining the functions of dissection, retraction, visualization of avessel within a workspace, and division of the vessel, would greatlybenefit both the patient and the operator.

[0010] Accordingly, a vessel harvesting device is provided. The vesselharvesting device comprises a shaft having a lumen for accepting anendoscope therethrough, a head piece connected to the distal end of theshaft. The headpiece creates a workspace which can be viewed through anendoscope that is inserted through the shaft. A vessel capturing means,operable within the workspace between an open and a closed position tocapture side branch vessels. The vessel capturing means is preferablycomprised of a flexible upper jaw and a rigid lower jaw. The devicepreferably has a handle which is connected to the proximal end of thehollow shaft. The handle allows the operator to manipulate the device.

[0011] The vessel capturing means can be opened and closed at thediscretion of the operator via an actuating means. Preferably, thevessel capturing means is opened when a tube which surrounds theflexible and rigid portions of the jaw and is retracted towards theproximal end of the device. To close the vessel capturing means, thetube is slid towards the distal end of the device. Upon the dissectionof a side branch vessel the operator opens the vessel capturing meansallowing the operator to place the side branch vessel inside of thevessel capturing means, effectively capturing the side branch vessel.Upon capture of the side branch vessel, the vessel capturing means isclosed.

[0012] The vessel capturing means can be fitted with ligation andtransection means. This allows the operator to capture, ligate, andtransect a side branch vessel without requiring of other instruments tobe inserted into the workspace. The transection means is preferably aknife edge housed in the lower jaw. The knife edge is drawn towards theproximal end of the device by an actuation means to cut a side branchvessel.

[0013] The ligation means is preferably a bi-polar electrode arrangementwherein the tube, which closes the jaws, is used as one electrode and araised portion of the cutting means is the other electrode. Upon captureof a side branch vessel in the movable jaw, the side branch vessel isligated by energizing the electrodes with RF energy.

[0014] Also provided is a method of removing a vessel utilizing theabove-described device. The first step in such a method involveslocating the vessel to be removed. Next an incision is made in thepatient to expose the vessel and the harvesting device is insertedthrough the incision in the usual manner. The head of the device is usedto dissect the vessel to be removed from the surrounding tissue. Upondissection, side branch vessels are exposed. The vessel harvestingmeans, located on the distal end of the device is then placed over theside branch vessel. The side branch vessels are then captured, thevessel capturing means is closed and the side branch vessel is held inplace by the now closed vessel capturing means. The side branch vesselsare then ligated and transected by the ligation and transection meanswhich are located in the vessel capturing means. The ligation means ispreferably a pair of bi-polar electrodes which are energized with RFenergy upon capture of the side branch vessels. The ligation means ispreferably a knife housed in a lower jaw of the vessel capturing means.The knife transects the ligated side branch vessel upon being drawn inthe proximal direction by the user via the actuating means.

[0015] This use of the vessel capturing means and the ligation andtransection means located therein limits the number of tools which mustbe inserted into the incision. Further, by having the ligation andtransection means located in the vessel capturing means, the procedureis more easily performed, and with a minimum of stress to the patientand in a decreased amount of time.

BRIEF SPRY OF THE DRAWINGS

[0016]FIG. 1 illustrates a perspective view of an endoscopic vesselharvesting device of the prior art.

[0017]FIG. 2 illustrates a perspective view of a surgeon and anendoscopic vessel harvesting device of the prior art harvesting a veinlocated in a persons leg.

[0018]FIG. 3 illustrates an enlarged perspective view of the endoscopicvessel harvesting of FIG. 1 inserted into a patient during a procedureto harvest a vein.

[0019]FIG. 4 illustrates a perspective view of the head piece of apreferred implementation of an endoscopic vessel harvesting device ofthe present invention.

[0020]FIG. 5 illustrates a perspective view of a preferredimplementation of the endoscopic vessel harvesting device of the presentinvention.

[0021]FIG. 6 illustrates an enlarged side view of the head piece of theendoscopic harvesting device of FIG. 4 in which the vessel capturingmeans is open and the vessel has been inserted.

[0022]FIG. 7 illustrates an enlarged side view of the head piece of theendoscopic harvesting device of FIG. 6 in which the vessel capturingmeans is closed around the vessel.

[0023]FIG. 8 illustrates an enlarged side view of a head piece for theendoscopic harvesting device of FIG. 7 in which a knife cuts the vessel.

[0024]FIG. 9 illustrates a top view of the actuating means, positionedsuch that the knife is housed in the lower jaw and the capturing meansis open.

[0025]FIG. 10 illustrates a top view of the actuating means positionedsuch that the knife is housed in the lower jaw and the capturing meansis closed.

[0026]FIG. 11 illustrates a top view of the actuating means positionedsuch that the knife has been actuated and the capturing means is closed.

[0027]FIG. 12 illustrates a cross sectional view of the capturing meansin which the capturing means is closed taken along line 12-12 of FIG. 7.

DESCRIPTION OF THE PREFERED EMBODIMENTS

[0028] Referring now to FIGS. 4 and 5, a preferred implementation of anendoscopic vessel harvesting device (EVH) for the removal of vesselsfrom a body is illustrated therein, generally referred to by referencenumber 100. Specifically, the EVH 100 is often used for the removal ofthe saphenous vein from the leg of a patient undergoing a CABGoperation. The embodiments discussed herein are directed to the removalof such a saphenous veins, however, it should be noted that they are notlimited to the removal of saphenous veins and could be utilized for theremoval of any vessel from a patient. As described above, traditionallythe procedure of removing the saphenous vein required the exchange ofvarious tools multiple times for each side branch ligation andtransection.

[0029] Accordingly, the EVH 100 is provided to overcome thedisadvantages of the prior art. The vessel harvesting device (EVH) 100comprises a shaft 112 having a lumen 111 therethrough for the insertionof an endoscope 106. The shaft is preferably formed of a rigid material,for example a medical grade stainless steel, or a rigid plastic. At theproximal end 112 a of the shaft is a handle 114, formed preferably of athermoplastic. At the distal end 112 b of the shaft is a head piece 116.The head piece 116 is preferably fabricated of a substantiallytransparent medical grade material such as polycarbonate.

[0030] Referring now to FIGS. 6-8, on the underside of the device andprojecting into the area defined by the head piece 116, often called aworkspace 140, is a vessel capturing means 130. The vessel capturingmeans 130 is designed to not interfere with the dissection process orwith observation of the dissection through the endoscope 106. During thedissection, the head piece 116 operates as is known in the art such asthat described in U.S. Pat. No. 5,667,480, and U.S. Pat. No. 5,722,934,both of which are incorporated herein by their reference. The preferredvessel capturing means 130 comprises a lower jaw 120, an upper jaw 121,a tube 122 for closing the vessel capturing means, a cutting means 123,and a knife edge 129, as shown in FIGS. 6, 7 and 8.

[0031] The lower jaw 120 is comprised of rigid material that resistsmovement and operates as a foundation for the other components. Therigid material is preferably formed of a polycarbonate plastic. Theupper jaw 121 is formed of flexible material and it is preferably thisportion of the vessel capturing means 130 that moves between the openand closed positions. The flexible material is preferably also apolycarbonate plastic but formed with a smaller thickness than the upperjaw. The flexible upper jaw 121 has a low profile to limit interferencewith the head piece 116. When in the open or original position the upperjaw 121 is upwardly biased, preferably by the spring tension of theflexible material. When in the closed position the flexible upper jaw121 is compressed against the lower jaw 120. The flexible upper jaw 121is preferably shaped so that the distal end 121 a of the flexible jaw121 projects upwardly towards the head piece 116. This upturned distalend 121 a of the upper flexible jaw 121 assists in the capture of thevessels. The upper flexible jaw is preferably accommodated with a gap131 which allows for the passage of a transection means through theflexible upper jaw 121. The upper and lower jaws 120, 121 may optionallybe molded as a single piece.

[0032] As shown in FIGS. 4 and 12 the vessel capturing means 130 ispreferably equipped with a transection means such as knife edge 129 ofcutting means 123 slidingly housed a slot 141 in the lower jaw 120. Theknife edge 129 is preferably formed of a medical grade heat treatedstainless steel, wherein at least the knife edge 129 is hardened tomaintain its sharpness throughout the life of the EVH 100. Preferably,the knife edge 129 is formed on only one side of the cutting means 123,and cuts in one direction. The cutting means 123 is actuated, by anactuation means 127 located in an actuation means housing 128 on theproximal end 112 a of shaft 112. While the knife edge 129 is stored inthe lower jaw 120, a raised portion 132 of the cutting means 123protrudes vertically above the level of the lower jaw 120, as can beseen in FIG. 12. The cutting means 123 is preferably formed of aconductive material such as a medical grade stainless steel. The cuttingmeans 123 is electrically connected to an RF energy generating source(not shown) and is coated with an electrically insulating material suchas parylene-n except for the raised portion 132 which contacts tissue.The cutting means 123 is slidably housed in a slot 141 in the lower jaw120. A portion of the lower jaw 120 prevents the knife edge 129 frombeing exposed when the knife edge 129 is in the stored position, asshown in FIG. 7. The gap 131 in the upper jaw 121 facilitates thecutting of captured vessels by allowing the cutting means 123 and knifeedge 129 to be actuated in the proximal direction 150, withoutinterference of the upper jaw 121. Upon a movement in the proximaldirection 150 the knife edge 129 extends vertically through the gap 131and above the level of the upper jaw 121, the knife edge 129 transectinga captured vessel.

[0033] The tube 122 is formed of a conductive material, for example amedical grade stainless steel, and is connected to an actuating means125. Tube 122 is formed of an upper arm 122A and a lower arm 122. Theupper and lower arms 122A,B are separated from one another so that whentube 122 is moved in the distal direction 160 a vessel captured betweenthe upper and lower jaws 120, 121 can be accommodated between the upperand lower arms 122A,B so that only a left edge 171 and a right edge 172of the tube 122 directly contact the vessel. Left and right edges 171,172 are electrically active and have the opposite polarity of raisedportion 132 of cutting means 123. Attached to the inside of upper arm122A of tube 122 is a spacer 133 as show in FIG. 12, which moves alongwith the tube 122. The spacer is preferably made of medical gradeplastic and can be attached to the tube using glue or other affixingmeans known in the art. The spacer assists in flattening the upper jaw121 against the lower law 120, when the vessel capturing means 130 isclosed.

[0034] The actuating means 125 comprises preferably at least one controlknob 126, 127 connected to the tube 122, which allows the user to movethe tube in both the distal 160 and proximal 150 directions relative tothe upper and lower jaws 121, 120. The tube 122, when moved towards thedistal end 161 of the EVH 100, surrounds the upper and lower jaws 121,120 and forces the flexible upper jaw 121 in the direction of the rigidlower jaw 120, effectively closing the vessel capturing means 130. Thetube 122 is of small enough diameter that upon closure the upper 121 andlower 120 jaws are compressed together. To open the vessel capturing 130means the tube 122 is moved in the proximal direction 150. This releasesthe pressure on the upper flexible jaw 121, and the spring tension ofthe flexible material of the upper flexible jaw 121 causes the vesselcapturing means 130 to resume its original shape. The vessel capturingmeans 130 does not “open” like traditional jawed devices but returns toits original shape. This is advantageous over other known devices as theprofile of the device is smaller and the upper jaw 121 does notinterfere with the headpiece 116 when the vessel capturing means 130 isin the original or opened position.

[0035] The actuation means 125 preferably comprises at least one controlknob 126, 127, one of which is connected to the tube 122 for closing themovable jaw 130 and the other is connected to the cutting means 123. Theactuation means 125 includes a housing 128 into which the proximal endof the tube 122 is inserted. A control knob 126 connects to the tube 122through the actuation means housing 128. One of the control knobs 126,127 acts on the proximal end of the tube 122 and manipulates the tube122 as a control rod. Similarly, control knob 127 connects to a controlrod (not shown) connected to the cutting means 123 via the actuationmeans housing 128. A control rod (not shown) for the cutting means 123connects the control knob 127 to the cutting means 123 and preferablyruns through a lumen 133 of the tube 122. The cutting means 123 and thetube 122 move independently of one another and both move in a one to onefashion with the control knobs 126, 127 respectively. It is the movementof the control knobs 126 and 127, as shown in FIGS. 9-11, which causesthe movements of the components at the distal end 161 of the EVH 100, asshown in FIGS. 6-8. The movements of the components of the EVH 100 inFIGS. 6-8 and 9-11 correspond to one another, respectively.

[0036] In FIGS. 6 and 9, the vessel capturing means 130 is opened by theoperator, by moving a control knob 126 towards the proximal end of theEVH 100. The control knob 126 is connected to tube 122 and a proximalmovement thereof results in a corresponding proximal movement of thetube 122. This is usually done upon the exposure of a side branch vesselwhich needs to be ligated and transected during the harvestingprocedure. The opening of the vessel capturing means 130 by movingcontrol knob 126 towards the proximal end 151 of the EVH 100 allows theside branch to be placed under the biased flexible upper jaw 121 asshown in FIG. 6. Preferably, this is performed by opening the vesselcapturing means 130, and moving the EVH 100 in the direction of theexposed vessel so that the vessel enters the vessel capturing means 130.The vessel is positioned under the opened flexible upper jaw 121 and ontop of the rigid lower jaw 120. Upon entry of the vessel into the vesselcapturing means 130, the capturing means 130 can be closed by slidingthe tube 122 in the distal direction 160.

[0037] As shown in FIGS. 7 and 10, closing of the vessel capturing means130 results in the vessel being captured by the EVH 100. This isperformed by moving control knob 126 distally which results in acorresponding movement in the distal direction 160 of the tube 122connected thereto. The tube 122 encircles the flexible upper jaw 121 andrigid lower jaw 120 and forces the vessel capturing means 130 to close.With the vessel in this location the vessel can be ligated andtransected.

[0038] As shown in FIGS. 8 and 11, upon closing of the vessel capturingmeans 130, the captured vessel is compressed between the flexible upperjaw 121 and the rigid lower jaw 120. One of the features of the presentinvention is that the vessel capturing means 130 is preferably fit witha ligation, and transection means. The ligation means is preferably atleast two electrodes which can be energized with RF energy. A preferableelectrode configuration is shown in FIG. 12, where one electrode ispreferably the tube 122, which closes the vessel capturing means 130,the second electrode is preferably the raised portion 132 of the cuttingmeans 123 which is preferably raised above the surface level of thelower jaw 120. Alternatively the portion of the cutting means 123 can belevel with the lower jaw 120, or recessed below the lower jaw 120.Additionally, the cutting means 123 is coated with an insulativematerial such as parylene-n except on the raised area 132 which contactsthe vessel. The respective electrodes are connected to an RF energygenerator as is known in the art. Upon closing of the vessel capturingmeans 130, the compression of the upper jaw against the lower jawpreferably causes any fluid in the vessel to be forced laterally awayfrom the area being compressed. This reduces the spread of vaporizingfluids from the sides of the vessel capturing means 130, thus limitingthe thermal injury to the vessel and surrounding tissue when theelectrodes are energized with RF energy. In an alternate embodiment,knife edge 129 of the cutting means 123 is not coated with anelectrically insulative material. This allows the complete sharpening ofthe knife edge 129 after the coating process is completed. A trade offwith this alternate embodiment, however, is that un-insulated, knifeedge 129 can contacted tissue while RF energy is being applied,therefore, the current density on the knife edge 129 could be higherthan desired and the quality of the coagulation could be compromised.The cutting means 123 is preferably actuated by moving control knob 127in a proximal direction 150, which results in a corresponding proximalmovement of the cutting means 123 operatively connected thereto. Thismovement transects a captured and ligated side branch vessel.

[0039] This cutting of the side branch vessels without the use ofextraneous tools results in a more efficient procedure which causes lesstrauma to the patient. Further, the minimization of tool exchanges,created by the combination of several features into a single instrumentsimplifies the procedure making it more applicable to a wider range ofpotential users.

[0040] The traditional method for the removal of the saphenous vein iswell known in the art and shown in FIGS. 1-3. Initially, an incision 3is made in the patients leg 2. The incision is typically three or fourcm in length and provides access to the vessel 7. The vessel 7 issurrounded by tissue from which it must be dissected. This isaccomplished using the edge 17 of the headpiece 16 of the harvestingdevice 10. This allows the vessel to be accessed by the harvestingdevice 10 and through the dissection the head provides a workspace 18 tocontinue the dissection and proceed with removal of the vessel 7. Duringthe dissection process, the operator will uncover numerous side branchvessels which are attached to the saphenous vein. Typically, 10 to 15side branches are uncovered in a procedure to remove 18 inches ofsaphenous vein from the upper and lower leg. Each of these side branchvessels must be individually dissected, ligated and transected so thatthe saphenous vein may be removed.

[0041] A method of removing the saphenous vein using the EVH 100 asdescribed above will now be discussed with reference to the Figures.Those skilled in the art will appreciate that the methods of the presentinvention limit the number of extraneous tools which must be insertedinto the same incision.

[0042] The method includes the steps of locating the vessel to beremoved, making an incision, and inserting the EVH 100 into theincision. The blunt dissection of the vessel is performed by moving thehead piece 116 of the EVH 100 along the vessel. This separates thevessel from tissue above the vessel and exposes the vessel to the EVH100. Separation of the vessel from tissue beneath the vessel isperformed using the tip and sides of the head piece 116. The operatormoves the handle from side to side and longitudinally in a reciprocatingfashion to continue dissecting the vessel. Once the vessel is exposed,and separated from the surrounding tissue, a workspace 140 is defined bythe head piece 116. The workspace provides a location for the attachedvessel capturing means 130 to be operated.

[0043] The vessel will undoubtedly have a number of side branch vesselsconnected to it. Each of these will have to be individually ligated andtransected before removal of the vessel. Upon the exposing of a sidebranch vessel the headpiece 116 can be placed over the side branchvessel with the upper flexible jaw 121 in the opened position. With theflexible upper jaw 121 opened, the side branch vessel is positionedunder the flexible upper jaw 121 and on the rigid lower jaw 120 bymanipulation of the handle 114 of the endoscopic vessel harvestingdevice. The entry of the side branch is facilitated by the upturneddistal end 121 a of the flexible upper jaw 121. Upon entry of the sidebranch vessel into the vessel capturing means 130, the flexible upperjaw 121 is closed by the surgeon by moving the tube 122 towards thedistal end 161 of the EVH 100.

[0044] The captured vessel is then compressed by the closing of thevessel capturing means 130. The side branch vessel is sandwiched betweenopposing sides of the flexible upper jaw 121 and rigid lower jaw 120.

[0045] The vessel capturing means 130 may also be fitted withtransection and ligation means. These means are actuated by the operatorusing their respective controls. The surgeon can actuate the ligationmeans, which are preferably a pair of electrodes, by energizing theelectrodes 122 and 123 with RF energy via a switch (not shown) locatedin the handle 114 of the EVH 100 or by using a foot pedal (not shown) asis common in the art. With the vessel capturing means 130 closed and theside branch vessel between the upper flexible jaw 121 and lower rigidjaw 120 RF energy can be supplied to the electrodes, one of which ispreferably the tube 122 used to close the jaw and the second electrodeis preferably a raised portion 132 of the cutting means 123, thiseffectively ligates or cauterizes the side branch vessel.

[0046] After the side branch vessel is ligated it can be transected. Theside branch vessel can be transected using a knife edge 129 located oncutting means 123 which is housed in the rigid lower jaw 120. This knifeedge 129 is actuated by manipulating control knob 127 on actuating means125 towards the proximal end of the device 151. Upon transection of theside branch vessel the surgeon can proceed with the dissection of thevessel and move to the next side branch vessel requiring ligation andtransection.

[0047] Those skilled in the art will appreciate that the methods of thepresent invention do not require the insertion of any extraneous toolsto perform the transection and ligation procedure. Nor do they requiremultiple tool exchanges. Accordingly, the procedure as a whole is fareasier, and efficient that those previously known. As a result thestress on the patient is reduced.

[0048] Although only a few exemplary embodiments of this invention havebeen described in detail above, those skilled in the art will readilyappreciate that many modifications are possible without materiallydeparting from the novel teachings and advantages of this invention.Accordingly, all such modification are intended to be included withinthe scope of this invention as defined in the following claims.

What is claimed is:
 1. A device for harvesting a blood vessel,comprising: a shaft having a lumen configured to accept an endoscope,the shaft having a proximal end and a distal end; a handle connected tothe proximal end of the shaft; a head piece connected to a distal end ofthe shaft; a holding means connected to the shaft and spaced apart fromthe head piece for holding the blood vessel; and a transecting meansconnected to the shaft for transecting the blood vessel.
 2. The deviceof claim 1, wherein the lumen is disposed between the handle and theholding means.
 3. The device of claim 1, further comprising ligationmeans for ligating the blood vessel.
 4. The device of claim 3, whereinthe head piece defines an area between tissue overlying the blood vesseland tissue underlying the blood vessel.
 5. The device of claim 4,wherein the holding means and the transecting means are concurrentlydisposed in the defined area.
 6. The device of claim 5, wherein theholding means, the transecting means and the ligating means areconcurrently disposed in the defined area.
 7. The device of claim 4,further comprising at least one electrode disposed within the definedarea.
 8. The device of claim 7, further comprising a second electrodedisposed within the defined area.
 9. The device of claim 1, wherein saidtransecting means is slidable relative to the shaft.
 10. The device ofclaim 1, wherein the head piece is configured to separate tissue fromthe blood vessel.
 11. The device of claim 1, further comprising a firstactuation means for operating the holding means.
 12. The device of claim11, further comprising a second actuation means for operating thetransecting means.
 13. A device for harvesting a blood vessel,comprising: a shaft having a lumen configured to accept an endoscope,the shaft having a proximal end and a distal end; a handle connected tothe proximal end of the shaft for manipulating the device; a head piececonnected to a distal end of the shaft; a vessel holder connected to theshaft and spaced apart from the head piece for holding the blood vessel;and a vessel cutter connected to the shaft for cutting the blood vessel.14. The device of claim 13, wherein the lumen is disposed between thehandle and the vessel holder.
 15. The device of claim 13, furthercomprising a ligator for ligating the blood vessel.
 16. The device ofclaim 15, wherein the head piece defines an area between tissueoverlying the blood vessel and tissue underlying the blood vessel. 17.The device of claim 16, wherein the vessel holder and the vessel cutterare concurrently disposed in the defined area.
 18. The device of claim17, wherein the vessel holder, the vessel cutter and the ligator areconcurrently disposed in the defined area.
 19. The device of claim 16,further comprising at least one electrode disposed within the definedarea.
 20. The device of claim 19, further comprising a second electrodedisposed within the defined area.
 21. The device of claim 13, whereinsaid vessel cutter is slidable relative to the shaft.
 22. The device ofclaim 13, wherein the head piece is configured to separate tissue fromthe blood vessel.
 23. The device of claim 13, further comprising a firstactuator for operating the vessel holder.
 24. The device of claim 23,further comprising a second actuator means for operating the vesselcutter.
 25. A method of harvesting vessels comprising: providing avessel harvesting device comprising a shaft having a lumen configured toaccept an endoscope, the shaft having a proximal end and a distal end, ahandle connected to the proximal end of the shaft for manipulating thedevice, a head piece connected to a distal end of the shaft, a vesselholder connected to the shaft and spaced apart from the head piece forholding the blood vessel, and a vessel cutter connected to the shaft forcutting the blood vessel; locating a vessel to be harvested; making anincision to expose the vessel; inserting the vessel harvesting deviceinto the patient through the incision; dissecting the vessel from thesurrounding tissue with the vessel harvesting device; holding a sidebranch of the vessel using the vessel holder; transecting the sidebranch of the vessel using the vessel cutter; and removing the vessel.